Doctors are not scientists...

[Guest Kirsteen]

Hi there,

 

Here's an interesting editorial from this week's BMJ, courtesy of BMJ Editor, Richard Smith:

 

"'If doctors are not scientists', he says, 'then it seems odd to supply them, as

medical journals do, with a steady stream of original scientific studies.'

 

Doctors are not scientists

 

Some doctors are scientists - just as some politicians are scientists - but

most are not. As medical students they were filled full with information on

biochemistry, anatomy, physiology, and other sciences, but information does

not a scientist make - otherwise, you could become a scientist by watching

the Discovery channel. A scientist is somebody who constantly questions,

generates falsifiable hypotheses, and collects data from well designed

experiments - the kind of people who brush their teeth on only one side of

their mouth to see whether brushing your teeth has any benefit. Most

doctors follow familiar patterns and rules, often improvising around those

rules. In their methods of working they are more like jazz musicians than

scientists.

 

Questioning whether doctors are scientists may seem outrageous, but most

doctors know that they are not scientists. I once asked a room of perhaps

150 medically trained educators which of them thought of themselves as

scientists. About five put up their hands.

 

If doctors are not scientists then it seems odd to supply them, as medical

journals do, with a steady stream of original scientific studies. Teachers

and social workers are not sent original research. Nurses are sent some,

but are they simply aping the illogical ways of doctors?

 

The inevitable consequence is that most readers of medical journals don't

read the original articles. They may scan the abstract, but it's the rarest

of beasts who reads an article from beginning to end, critically appraising

it as he or she goes. Indeed, most doctors are incapable of critically

appraising an article. They have never been trained to do so. Instead, they

must accept the judgment of the editorial team and its peer reviewers -

until one of the rare beasts writes in and points out that a study is

scientifically nonsensical..."

 

Cheers,

Kirsteen

[Guest hacker]

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[Guest noncestvrai]

Good thing I acquired some skills outside med school..., now I have to get that cavity fixed...

 

noncestvrai

[Guest hacker]

What is that ?!!! I'll try posting again

[Guest hacker]

ok seems liek I cant post anything !

 

Hi Kirsteen,

 

I looked up the definition of scientist from some dictionary site and here is what it read ,

A person having expert knowledge of one or more sciences, especially a natural or physical science..

Obviously, doctors would have expert knowledge in several sciences which would enable them to diagnose and help treat diseases. So, I disagree with that article. Doctors are scientists and so are all of the people who have expert knowledge in any science.

Wouldn't the researcher/thinker be the one to generate falsible hypothesis and try to refute other ones. There's always an option to do that in med school 2..

 

cheers my scientist friend ,

H

[Guest Steve U of T]

Hacker, the ezboard software recognizes square brackets as associated with HTML. That might be the problem, so don't use square brackets.

 

Anyways, I suppose the important question that follows is whether or not patients would be better off if doctors were scientists.

[Guest Steve U of T]

That's just an issue of semantics. I took a course on the philosophy of science, and although this wasn't the focus of the course, I tend to agree with the article. I think science is the process of observing and gaining understanding of the universe, not the knowledge derived from that process. True, some may define a scientist as somebody knowledgable in a field based on science, but a true practitioner of science (which, for our purposes, is different from a scientist) must have the skills to generate such knowledge, and not simply apply it. I'm not so sure doctors actually practice science.

 

There are certainly similarities between the process of diagnosis and treatment, and science. A doctor looks at the signs and symptoms of the patient, and decides upon a diagnosis (hypothesis) based on the process of induction (i.e. deciding which disease is present by looking at similar patients from the history of medicine). However, the inference is something the doctor learned from someone else, and is not some bold conjecture he/she came up with.

 

By providing the treatment that has worked in the past for that disease, the doctor is testing a falsifiable hypothesis. If the patient improves, the hypothesis is supported. If not, the hypothesis may need to be refined. That seems to be science, although this type of 'experiment' isn't well controlled, so underdetermination has an enormous effect (underdetermination is the tendency of a series of premises to have multiple possible conclusions - i.e. the patient may not have the disease the doctor thinks, but improves for reasons other than the treatment given). Underdetermination is considered one of the major arguments that science does not provide an accurate description of the universe. However, a scientific realist (somebody who believes that science provides an accurate description of the universe) would argue that 'good' science reduces or eliminates the problem of underdetermination. In this case, I believe underdetermination applies largely because the doctor isn't really carrying out a scientific experiment.

[Guest Koppertone]

The difference between a doctor and a "scientist" is simply that a doctor isn't looking at any overarching trends among his patients so that he can publish a paper and get a grant.

 

"A scientist is somebody who constantly questions,

generates falsifiable hypotheses, and collects data from well designed

experiments - the kind of people who brush their teeth on only one side of

their mouth to see whether brushing your teeth has any benefit. Most

doctors follow familiar patterns and rules, often improvising around those

rules."

 

You examine a patient. You generate a falsifiable hypothesis about what his afflication is. Whether a familiar pattern or rule is how to diagnose a patient or how you're going to breed 30,000 worms over and over again for your genetic mapping experiment, it's still just a rule that somebody has invented.

 

I also take issue with the notion that doctors "were never trained to read scientific articles". Umm... anybody remember undergrad? Maybe Richard Smith didn't do any research in his undergrad career, but many of us have prior to entering medicine.

 

There's a general misconception among people that doctors and scientists are at some incredibly higher echilon than other people, and anything that debunks these ideas always seem to astound. But my dad used to read the scientific articles that I'd have kicking around on yeast and nematodes and he had no problem reading them and finding faults in the experiments. And get this, he drove a bus. And so I see no reason why a doctor couldn't read and critique an article either.

 

That being said, yes doctors do work more on the practical side of things while "scientists" work more on the research end. That's why they're called practitioners and researchers.

[Guest strider2004]

I agree with the article. Most physicians are not trained to be scientists. Most physicians do not contribute to the scientific community, they only learn from it and apply it. Physicians are trained to be professionals, to be good at what we do. Ask a graduating medical class how many of them consider themselves scientists and you wouldn't get too many hands.

Many people going into medical school have a perception of the training that you may receive in med school - intellectual stimulation, exercising your mental abilities - but that's not how you're trained. Sure, in the first two years you may have a few lessons on critical appraisal but I'd be hard pressed to find a handful of people in my class who could give me six reasons why a control trial is valid and even fewer who have read any of the JAMA Users Guides to the Medical Literature.

I know all of this because I'm currently trying to learn more about critical appraisal and how to tell a slightly good paper from a slightly bad paper. It's not as easy as the really good ones and the really bad ones, obviously. How long does it take me to appraise an article? When I started...about an hour. Now...about 45 minutes. If I get it down to 30 mins, then I'll be happy.

 

As for semantics, there are physicians and there are scientists. There's also something called a physician-scientist - many of those have PhDs. That term wouldn't exist if every physician were a scientist, right?

[Guest drews97]

It's true that most doctors aren't scientists, and it's a good thing too as I wanted to become a doctor to avoid being a 'full-time' scientist. As someone with an undergrad in biology and lots of experience in lab work, I can say without hesitation that I personally prefer the process of applying medical knowledge to the (frequent) monotony of day-to-day basic science research. While most doctors aren't scientists, many that I have had a chance to work with do try to keep on top of current, relevant research. For example, a stroke conference I recently attended involved discussing the results of the latest clinical trials in detecting and treating TIAs. While many doctors do not 'contribute to the scientific community', I believe that most have the necessary skills and intelligence to critically assess the validity and usefulness of basic scientific research.

[Guest Kirsteen]

Hi there,

 

I also take issue with the notion that doctors "were never trained to read scientific articles". Umm... anybody remember undergrad? Maybe Richard Smith didn't do any research in his undergrad career, but many of us have prior to entering medicine.

Richard Smith is English. I don't know where he was educated but it's de rigeur in the U.K. to enter medicine straight from high school wherein students generally don't receive training in reading and interpreting scientific articles.

 

Also, with respect to Richard Smith, if you don't already, try to have a regular read of his editorials. He often comes out with some interesting views that frequently challenge current health care norms. I also had the opportunity to sit in on a small health care debate held in London a year and a bit ago. Richard was presiding, complete with one of those judge's wigs, gavel and the whole bit, and a great dose of humour. He's quite the guy.

 

Cheers,

Kirsteen

[Guest Titanium2003]

"While many doctors do not 'contribute to the scientific community', I believe that most have the necessary skills and intelligence to critically assess the validity and usefulness of basic scientific research".

 

I agree. However, critically appraising literature would not define a person as a scientist. Scientists must not only appraise methodologies and conclusions, they must generate their own and advance the knowledge base in their discipline. The work may be repetitive and boring to some, but given the number of trials and the myriads of variables to tease apart needed to test hypotheses, it is very important to repeat one's and other people's work and reach conclusions that direct the next step in research.

 

Doctors in that sense are consumers of this work rather than producers (some MD/Phds being a notable exception). In many ways, doctors are technicians who are privy to and applying a wide ranging science.

[Guest T dawg 2004]

As a student who has just finished a Bachelor's of Education I am a bit astounded by the statement in the article that teachers and social workers are not appraised with new research findings. I know that more and more, teachers ARE expected to remain current in their knowledge of educational research - and in fact many great teachers will maintain knowledge of the fields in which they teach (i.e. many science teachers read scientific journals). Although it is not mandated that they do so, a good teacher - just as a good physician - will stay on top of the current literature in their field. Often many people take to performing the least amount of work - and get lazy, neglecting their own continuing education. This occurs in every field where you can perform your job without a requirement for staying current.

 

Surely scientists and researchers may feel the burden that they MUST remain current - but that is simply because that *is* their job. For others, staying "current" is not a necessity, but it is a part of being good at your job.

[Guest s sadry]

i think the article tries to place an emphasis that scientists are constantly questioning their work adn the world aroudn them in order to come to some meaningful conclusion..

 

in contrast, i know many of GPs who after years of experinece..have seen the same symptoms, given the same diagnosis...and are no longer "challenged" by their work in the sense that they find it difficult. but since when does science correlate with difficulty??

 

maybe these doctors...who now do their works mindlessly after years of experience, cna be considered "experts" in their feild..just as we have "experts" in biochemistry for example.

[Guest ikaj]

I just finished a bachelors degree through the science faculty at the UofA. I wasn't really taught to read a scientific journal critically until my 4th year. If medical students are not trained to read scientific journals in med school and they had been accepted into medicine after 2nd year of their undergrad for example, I guess, as a doctor, they would not be able to read a paper as critically as a scientist would.

I think it's valuable to have some experience working as a summer student in lab. I believe quite a few med students have been exposed to scientific journals and lab work through just working as research students in the summer.